Bellin v. Zucker, 6 F.4th 463

Background

Rosalind Bellin, a Bronx Medicaid beneficiary, received an initial MLTC (RiverSpring) assessment in May 2019 that assigned 8 hours/day of in‑home personal care; she later received 24‑hour care after further assessments and a fair‑hearing ruling.
New York’s process: State CFEEC determines general eligibility and uses a Uniform Assessment System (UAS); beneficiaries then enroll with MLTCs, which perform comprehensive assessments and make initial hours determinations; there is no formal pre‑enrollment appeal mechanism for those initial MLTC determinations.
RiverSpring refused to treat Bellin’s pre‑enrollment challenge as an internal appeal, instead treating it as a request for additional hours that could be decided only after enrollment; Bellin pursued a State fair hearing and filed this putative class action under 42 U.S.C. § 1983.
The district court dismissed Bellin’s complaint, holding (1) federal Medicaid statutes/regulations do not require an appeal of MLTCs’ initial hours determinations and (2) Bellin failed plausibly to allege a constitutionally protected property interest in a particular initial level of care.
On appeal, the Second Circuit affirmed dismissal of Bellin’s federal statutory claims but vacated and remanded the due process dismissal, concluding Bellin plausibly alleged that MLTCs’ discretion is meaningfully channeled (so a property interest may exist) and that the adequacy of procedural protections requires further fact development.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Mootness: whether case is moot now that Bellin receives 24‑hr care	Bellin: case falls within inherently‑transitory exception; class relief still needed	State: Bellin’s individual injury resolved makes case moot	Held: Not moot — inherently‑transitory exception applies; class claims can proceed
Due process: whether beneficiaries have a protected property interest in MLTCs’ initial hours determinations	Bellin: regulations, contracts, UAS, policy and fair‑hearing practice meaningfully channel MLTC discretion, creating an entitlement to a defined level of hours	State/RiverSpring: decisions require medical judgment and subjective criteria; discretion not meaningfully channeled	Held: Dismissal premature — Bellin plausibly alleged a property interest; remand to develop factual record on limits to MLTC discretion and adequacy of procedures
Statutory: whether MLTCs’ initial pre‑enrollment determinations are “adverse benefit determinations” triggering internal‑appeal/notice rules (42 U.S.C. §1396u‑2; 42 C.F.R. pt. 438)	Bellin: initial determinations limit benefits and thus are adverse determinations requiring notice and appeal rights once enrolled	State: ‘‘Adverse benefit determination’’ applies to denials of requested services by enrollees; pre‑enrollment informal statements are not statutory requests	Held: Statutory claim rejected — regulations unambiguously tie adverse‑determination protections to requests by enrollees, not pre‑enrollment assessments
Statutory: whether §1396a(a)(3) fair‑hearing rights require immediate appeal of MLTC initial determinations	Bellin: managed‑care rules should preserve fee‑for‑service fair‑hearing rights for initial hours denials	State: Congress and CMS adapted appeal procedures for managed care; internal remedies are required first	Held: Statutory claim rejected — CMS/Medicaid managed‑care framework contemplates internal plan appeals first; no textual basis to import fee‑for‑service timing into managed‑care initial assessments

Key Cases Cited

Barrows v. Burwell, 777 F.3d 106 (2d Cir. 2015) (holding dismissal was premature where practice may substitute for discretionary medical judgment)
Kapps v. Wing, 404 F.3d 105 (2d Cir. 2005) (explaining property‑interest inquiry and need to examine statutes/regulations that channel discretion)
Sealed v. Sealed, 332 F.3d 51 (2d Cir. 2003) (administrative scheme must meaningfully channel official discretion to create entitlement)
Furlong v. Shalala, 156 F.3d 384 (2d Cir. 1998) (consistent administrative decisions can create a protectable property interest)
Bd. of Regents v. Roth, 408 U.S. 564 (1972) (property interests arise from existing rules or understandings, not the Constitution)
Salazar v. King, 822 F.3d 61 (2d Cir. 2016) (articulating the inherently transitory exception to mootness for class actions)
Robidoux v. Celani, 987 F.2d 931 (2d Cir. 1993) (applying inherently transitory doctrine where administrative processing likely moots individual claims)
Zurak v. Regan, 550 F.2d 86 (2d Cir. 1977) (same)
Yale Auto Parts, Inc. v. Johnson, 758 F.2d 54 (2d Cir. 1985) (no protected interest where decisionmaking governed by broad, subjective public‑interest standards)